New pain means new problem?

Question fromPJ:
My breast has been painful during a week of every month since my treatment ended one year ago. (Lumpectomy, radiation). Recently, the pain is daily and is in the ribs below my breast. I take 2mg Dilaudid, which helps for about four hours. I'm not as concerned about the pain as I am about what it means. Does new pain always mean a new problem?

Answers -Ann Berger
I'm not sure whether you are taking dilaudid once a day or every four hours. If you need it every four hours, your pain is severe enough that you should get tests to rule out metastatic cancer. If you're taking it once a day, and the pain is relieved for the day, it sounds like what the person just before described. But particularly where you're describing it at the ribs and chest wall area, if x-rays are normal and exam is normal, then be reassured that this is probably not cancer. Yes, it's fine if you take the Dilaudid every day.

Pain and palliative care, symptomatic management, and dealing with quality of life issues are probably the fastest growing medical fields right now. Lots of research is being done in these areas, and a lot more emphasis is being put on the importance of treatment of symptoms and of the whole person. It's now becoming a requirement from the Joint Commissions that all institutions look at pain. Soon, it will be pain and other symptoms because, basically, it's part of a patient's bill of right not to have these symptoms. So as more and more research is being done on it, there's more and more acceptance in the medical field that these are important issues that need to be dealt with.

Marisa C. Weiss, M.D.
It can be very helpful to prepare a report about your pain before you go to the doctor. Think about what the nature of the pain is, where it's located, what makes it better, what makes it worse, and if there are other symptoms that go along with the pain. Another thing that can make communication difficult is that many people have different words for pain. For example, I have many times asked a patient if she's having any pain and she might say, "No," but she might then add, "But I am having some discomfort," or "I do have an ache or some soreness," or "I have a nagging problem over here." So it is important to make your doctor understand what's bothering you and what's getting in your way of feeling comfortable each day and night so that you can return to a life that is enjoyable, fun, and fulfilling.

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